Pathophysiologic and psychodynamics of disease causation

1. Ms. NAMITA BATRA GUIN
ASSOCIATE PROFESSOR,

2. Disease
 Disease is a term that can be described as an alteration
in body function resulting in a reduction of the
capacities or the short-comings of the normal life
span.

3. Common Causes of the diseases
 Biologic agents- viruses, bacteria, rickettsia, fungi, protozoa,
helminthes, & toxins.
 Inherited genetic defects
 Developmental defects resulting from exposure to
environmental elements (e.g. Viruses & chemicals )
 Physical agents- e.g. Temperatures extremes, radiation &
electricity.
 Chemical Agents- e.g. Alcohol, strong acids or bases, many
drugs, heavy metals & industrial poisons.
 Tissue response to irritation or injury
 Faulty chemical or metabolic processes – e.g. Excessive or
inadequate production of body secretions, such as hormones &
enzymes.
 Emotional & physical responses to stress

4. PSYCHODYNAMICS
 It is defined as human behavior, either external or
internal which can lead to its state of health or disease.
 In Medical practice-“The systematized study and
theory of the psychological forces that underlie human
behavior, emphasizing the interplay between
unconscious and conscious motivation and the
functional significance of emotion.

5. PATHOPHYSIOLOGY
 Pathophysiologic processes result when cellular injury
occurs at such a rapid rate that the body’s
compensatory mechanisms can no longer make the
adaptive changes necessary to remain healthy.
 E.g. In the development of heart failure, the body
reacts by retaining sodium and water and increasing
venous pressure, which worsens the condition.

6. BODY- THE DYNAMIC BALANCE- A
STEADY STATE
 The person, as a living system, has both an internal
and an external environment. Information and matter
are continuously exchanged between are environment
and the other. Within the internal environment each
organ, tissue and cell is also a system or a subsystem of
the whole, each with its own internal and external
environment, each exchanging information and
matter.
 The goal of the interactions of body’s subsystem is to
produce a dynamic balance or a steady state so that all
the subsystems are in harmony with each other.

7. FOUR CONCEPTS
 Constancy
 Homeostasis
 Stress
 Adaptation

8. FOUR CONCEPTS
 Constancy : Claude Bernard, a 19th century French
physiologist, developed the biological principle
that for life, there must be constancy or “fixity of
internal milieu” despite changes in the external
environment. The ‘internal milieu’ was the fluid
that bathed the cells, and the constancy was the
balanced internal state maintained by physiologic
and biochemical process.

9. FOUR CONCEPTS
 HOMEOSTASIS : The concept of homeostasis was
first introduced by WB Cannon (1939). He viewed
human being as separate from the external
environment and constantly endeavoring to maintain
physiologic equilibrium or balance, through
adaptation to that environment. Homeostasis then is
the tendency of the body to maintain a state of balance
or equilibrium while continually changing.
 It can be :
 Physiologic homeostasis.
 Psycho logic homeostasis

10. FOUR CONCEPTS
 HOMEOSTASIS :
 Physiologic homeostasis: It means that the internal environment of
the body is relatively stable and constant. All cells of the body require a
relatively constant environment to function, thus the body’s internal
environment must be maintained within narrow limits.
 Homeostasis mechanisms have 4 main characteristics:-
 They are self-regulating.
 They are compensatory.
 They level to be regulated by negative feedback
systems.
 They may require several feedback mechanisms to
correct only are physiologic imbalance.

11. FOUR CONCEPTS
 HOMEOSTASIS :
 Self-regulating: means that haemostatic
mechanisms come into play automatically in a
healthy person.
 Compensatory: because they tend to counteract
conditions that are abnormal for a person. E.g.
sudden drop in temperature.
 Feedback: some of the culprit of a system is
“feedback” into the system as an input.

12. FOUR CONCEPTS
 HOMEOSTASIS :
 PSYCHOLOGIC HEMOSTASIS: refers to emotional or
psycho logic balance or a state of mental well-being. It is
maintained by a variety of mechanisms. Each person has
certain psycho logic needs, such as need for love,
security and self-esteem that must be met to maintain
psycho logic homeostasis.
 Psycho logic homeostasis is acquired or learned through
the experience of living and interacting with others. In
addition, societal norms and culture influence behavior.

13. PREREQUISITES TO DEVELOP
PSYCHOLOGIC MANIFESTATIONS
 A stable physical environment in which the person feels
safe and secure. E.g. the basic needs for food, shelter
and clothing must be met consistently from birth
around.
 A stable psycho logic environment from infancy onward,
so that the feelings of trust and love develop. Growing
children and adolescents also need kind but firm and
consistent discipline, encouragement and support to be
their own unique selves.
 A social environment that includes adults who are
health role models. Children learn the customs and
values of society from these individuals.

14. PREREQUISITES TO DEVELOP
PSYCHOLOGIC MANIFESTATIONS
 A life-experience that provides satisfactions throughout
life, people encounter many frustrations. People deal
with these better if enough satisfying experiences have
occurred to counterbalance the frustrating ones.

15. STRESS
 Stress is a state produced by a change in environment
i.e. perceived as challenging, threatening or damaging to
the person’s dynamic balance”.
 Stressor:
 It may be defined as “an internal or external event or
situation that creates the potential for physiologic,
emotional, cognitive or behavioral changes in an
individual”.

16. TYPE OF STRESSORS
 It may be :-
 Physical- cold, Heat, Chemical Agents.
 Physiologic- Pain, Fatigue.
 Psychosocial- Emotional Reaction.
 Others include:-
 Day to day frustrations: - E.g. Getting caught in a traffic jam,
having arrangement with spouse or roommate.
 Major complex occurrences involving large groups, entire
nations. Eg. Wars, terrorism demographic, economic,
technologic changes.
 Stresses that occur less frequently and involve few people e.g.
Death, birth, marriage, divorce, retirement, permanent
functional disability.

17. PHYSIOLOGIC MANIFESTATIONS OF
STRESS
 A stress response is a “cascade of neural and hormonal
events that have short and long-lasting consequences
for both brain and body.
 Interpretation of Stressful stimuli by the Brain:-
 It integrates with autonomic nervous system
mechanisms that maintain chemical constancy of the
internal environment of the body. Neural and neuro-
endocrine pathways under the control of the
hypothalamus are activated in the stress response. First,
there is a sympathetic adrenal medullary response, and
then hypothalamic pituitary response.

18. PHYSIOLOGIC MANIFESTATIONS OF
STRESS
 Sympathetic Nervous System Response
 The sympathetic nervous system response is rapid and short-
lived. Nor-epinephrine is released at nerve endings in direct
contact with their respective end organs to cause an increase
in function of vital organs and a state of general body
arousal.
 Sympathetic Adrenal Medullary Response
 the SNS stimulates the medulla of the adrenal gland to
release the hormones epinephrine and non-epinephrine into
the blood stream. Action of these hormones is similar to that
of the CNS and has the effect of sustaining and prolonging
its actions.

19. PHYSIOLOGIC MANIFESTATIONS OF
STRESS
 Hypothalamic Pituitary Response
 It is the long-acting phase of the physiologic response,
which is more likely to occur in a persistent stress.
 Anti-diuretic (post pituitary) and Aldosterone (adrenal
cortex) promote sodium and water retention which is an
adaptive mechanism in case of hemorrhage and shock.
 Growth hormone and Glucagon stimulates uptake of
amino-acids by cells thus mobilizing energy resources.
 Endorphins, an endogenous opiate, increase during
stress and enhance the threshold for tolerance of painful
stimuli.

20. PHYSIOLOGIC MANIFESTATIONS OF
STRESS
 E.g. :
 Pupils dilate to increase visual perception when serious
threat to the body arises.
 Sweat production (diaphoresis) increases to control
elevated body heat due to increased metabolism.
 The heart rate increases, which leads to an increased
pulse rate to transport nutrients and byproducts of
metabolism more efficiently.
 Skin is paled because of constriction of peripheral blood
vessels, an effect of nor-epinephrine.
 Urine-output decreases.
 The mouth may be dry.

21. PSYCHOLOGIC MANIFESATATIONS OF
STRESS
 It includes- Anxiety, Fear, and Anger, Depression, Cognitive
behaviors, verbal and motor Responses and unconscious ego-
defense mechanisms.
 Anxiety: -It is a state of mental uneasiness, apprehension, dread
or foreboding or a feeling of helplessness related to an
impending or anticipated unidentified threat to self a significant
relationships.
 Fear: - It is”a mild to severe feeling of apprehension about some
perceived threat”.
 Anger: - It is an emotional state consisting of a subjective feeling
of displeasure. It is expressed as altered verbal tone as a
communication to desist from some action or other.
 Depression: - It is a common reaction to events that seem
overwhelming or negative. It is manifested as- emotional,
behavioural and physical signs.

22. COGINITIVE MANIFESTATIONS
 Problem solving
 Structuring:-It is the arrangement or manipulation of a
situation so that the threatening events do not occur.
 Self control
 Suppression
 Fantasy or Day dreaming
 Prayer

23. VERBAL AND MOTOR MANIFESTATIONS
OF STRESS
 Crying
 Verbal Abuse
 Laughing
 Screaming
 Hitting and Kicking
 Holding and touching

24. ADAPTATION
 Adaptation results when the individual is able to effect
a series of behaviors and mental processes to
neutralizes the stress experience and re- establish
integrity of function. Adaptation involves achieving a
balance between perceived demands (stress) and
marsh led resources (copying) a state of reduced
anxiety and enhanced well-being”.

25. Modes of Adaptation
 Physiologic Mode /Biological adaptation- occurs in
response to increased altered demands placed on the body
and results in compensatory physical changes.
 Psycho logic adaptation: - involves changes in attitude and
behavior (e.g. Coping strategies) toward emotionally
stressful situations e.g. changing life style pattern, using
problem-solving approach in decision making.
 Socio-cultural Adaptation: - It involves changes in person’s
behavior in accordance with norms, conventions, and
beliefs of various groups such as family, society, ethnic
group, religious group, professional group and economic
group.

26. Characteristics of Adaptive Responses
 All adaptive responses are attempts to maintain homeostasis.
 Adaptation is a whole body or total body response.
 Adaptive responses have limits- Physiologic adaptive responses
are more limited than psycho logic or social responses.
 Adaptation requires time.
 Adaptability varies from person to person.
 Adaptive responses may be inadequate or excessive eg.
Inflammatory response of body to bacterial invasion and
allergen.
 Adaptive responses are ego centric and tiring because they
require body energy and tax physical and psychological
resources.

27. Dimensions of adaptation
 Physical
 Developmental
 Emotional
 Intellectual
 Social
 Spiritual

28. Adaptation syndrome
 GAS:- GENERAL ADAPTATION SYNDROME
 The GAS is a physiological response of the whole body
to stress. It involves several body systems, primarily the
autonomic nervous system and the endocrine system.
 LAS: - LOCAL ADAPTATION TO STRESS
 The body produces many localized responses to stress.
These include blood clotting; wound healing,
accommodation of the eye to light, and response to
pressure.

29. Adaptation to stress
 Alarm Reaction
 Stage of Resistance
 Stage of Exhaustion

30. ILLNESS
 When the adaptive mechanisms or coping strategies
fails to maintain body in a dynamic steady state or get
exhausted, an illness results.
 Those who become ill have to adapt to the demands of
different stages of illness.
 In the cycle of illness- most people go through 3
stages:-
 1st Stage- Transition from Health to illness
 2nd Stage- Period of Accepted Illness
 3rd Stage- Convalescent stage

31. Illness Behavior
 It is “any activity undertaken by a person who feels ill, to define the
stage of his health and to discover a suitable remedy
 IGUN’s 11 stages of illness Behavior/ Health seeking:-
 Symptom experience:
 Self -treatment or Medication
 Communication to others
 Assessment of symptoms
 Sick Role assumption
 Concern
 Efficacy of treatment
 Selection of treatment
 Treatment
 Assessment of effectiveness of treatment
 Recovery and Rehabilitation

32. NURSING IMPLICATIONS
 Promoting Healthy Lifestyle
 Enhancing Copying strategies
 Teaching Relaxation Exercises
 Educating
 Enhancing Social support
 Recommending support and Therapy Group Crisis
Intervention.